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Tell an elderly patient to take a red pill when they have three other medications that are similar in color, and the patient is likely to be confused. It is not because they are unable to learn how to take their medication, it’s just that the teaching technique is all wrong, says Betty Halsey, RNC, MS, director of the Senior Care Program at St. Joseph’s Hospital in Tampa, FL.
As people grow older, they experience sensory deprivation and psychological changes that alter their way of understanding and taking in new information and processing it, she explains.
Most elderly want to be compliant, agrees Martha Kieffer, RN, MS, Advantage Program coordinator at Mercy Center for Healthcare Services in Aurora, IL. "Most seniors want to be part of the health care team. They want to get as much information as possible, but they may learn at a slower pace," says Kieffer.
To improve learning and increase compliance among seniors, Halsey and Kieffer suggest the following teaching methods:
• Take visual barriers into account.
Many seniors have poor eyesight, difficulty adapting to light, and a poor perception of color. Therefore, if the nurse tells them to take a red pill in the morning, they may not be able to distinguish it from the orange pill they are taking or the brown one, says Halsey. It is better to work with the patient, spend time helping them to understand what the medicine is for rather than assuming that they can’t learn and simply instructing them according to the color.
In a classroom situation, make sure all handouts are in large print, and if slides or overhead illustrations are used, make sure the room is darkened, advises Kieffer.
• Allow for a hearing deficit.
Because many seniors are hard of hearing, health care workers should face them when talking to them. "I have gone into a patient’s room and stopped to open the shades, and while I have my back to them I’ll start teaching about their diabetes or medication. What they needed was eye contact, so if there is a hearing deficit, they can see my lips and hear the words I am speaking a whole lot better," says Halsey.
If teaching a group, consider using a microphone, even in a small room, says Kieffer. Also, consider outside noise such as fans and blowers when selecting a classroom.
• Make sure a thorough assessment has been made.
There are many reasons a patient is not compliant. For example, an elderly man at St. Joseph’s was readmitted to the hospital a month after discharge with a massive stroke, even though he seemed to understand the importance of taking his prescribed medicines for hypertension. He didn’t take the medications because he couldn’t afford to pay rent, buy groceries, and pay for the medicine. "We need to get to know our patients so we’ll know if there is a problem such as cost," says Halsey.
It’s a good idea to learn what kind of a support system the patient has. For example, there may be someone to make sure they take their medications and provide transportation to pick up the prescriptions. If a patient doesn’t have a support system, a social worker may be able to connect the patient with a community agency.
• Provide outreach programs.
St. Joseph’s Hospital has a program for people more than 50 years old called Senior Care. They receive a monthly postcard alerting them to activities they may want to participate in that are sponsored by the hospital. These include a mall-walking program and a swimming program. "We try to do things that are geared towards wellness for the elderly and to dovetail into the other specialty areas and wellness programs we have going on throughout the health system," says Halsey. The hospital also has a helpline for seniors where they can call if they have a question or need a physician referral.
At Mercy Center, the senior program sponsors several support groups such as "Better Breathers" for people with pulmonary problems and "Happy Heart" for people with cardiac problems. Just getting together to talk can be therapeutic, says Kieffer.
• Help health care workers understand the elderly.
When Halsey noticed many health care workers didn’t want to take care of the elderly or didn’t know how to interact with them, she launched a sensitivity class. In this class, participants role-play so they can learn what it is like to be old. "We take [eye] glasses that are purposely marked or covered with Vaseline [to distort vision], put gloves on people so they have awkward hands simulating an arthritic condition that would be difficult to open pill bottles, and then we role-play," says Halsey.
Participants pretend they are being admitted to the hospital and are asked to fill out a questionnaire and sign in under rushed conditions. They also are given bottles of pills and asked to pull out a red pill, green pill, and yellow pill. "After the exercises, we have the people take the gloves and glasses off, and they are amazed to find they haven’t gotten the right colors after all," says Halsey. The class helps change people’s perception of the elderly and eliminates much of the condescending attitude many health care workers have when working with seniors.